91Ӱ��

On the morning she died, Ashleigh Anderson researched her symptoms.

Nausea.

Jaw pain.

Chest pain.

Cold sweats.

“I think I am having a heart attack,” the 41-year-old texted her longtime boyfriend from the CVS store in Seymour, Indiana, where she had just begun her shift as the sole pharmacist on duty.

It was Sept. 10, 2021. Retail pharmacy was reeling from the pressures of the pandemic, and frontline workers like Anderson were dangerously burned out. For months, they had been filling prescriptions and vaccinating patients without bathroom breaks or a bite to eat.  

Anderson’s phone buzzed.

“I hope not!” replied her boyfriend, Joe Bowman, who suggested the symptoms could just as easily be indigestion, stress or something with her lungs.

Anderson was a smoker, and her job induced plenty of stress. But she had just been to the doctor two weeks earlier and, according to her family, received a clean bill of health.

“Can you take a long lunch and decompress?” Bowman asked.

“I can’t,” she texted back.

The CVS in Seymour was a 24-hour store whose pharmacy counter never closed, not even for lunch. Patients came at all hours to pick up medications, ask questions and get shots. It was a relentless grind made worse by the recent departure of two staff pharmacists and the pharmacy manager. In their absence, the remaining crew struggled to fill the hundreds of prescriptions coming in each day and had soon fallen behind by more than 1,000.

Tensions were especially high that week after Anderson learned her boss had assigned her the role of pharmacy manager despite her repeated refusals to take the promotion.

“I am livid,” she messaged a coworker four days earlier when she discovered the change in the company’s HR system.

State law at the time required every pharmacy to designate a pharmacist in charge, someone to hold accountable for complying with regulations and to discipline for violations.

But Anderson didn’t want the extra responsibilities. After 17 years with CVS, including previous stints as a manager, she was content being a regular staff pharmacist. She could clock in, clock out, and go home to Bowman and her beloved basset hounds without the job following her there.

If anyone could handle the gig, though, it was Anderson. 

Whip-smart, selfless and dependable, she had managed one of the busiest CVS pharmacies in Indiana just a few years out of college. When a historic flood inundated her store in 2008, she kept working until the National Guard arrived in boats to rescue everyone. The following year, she won the company’s highest honor, the coveted Paragon Award.

Anderson was calm amid chaos. But that morning when she texted Bowman, she was worried.

If she was having a heart attack, she needed immediate medical attention. But if she left without another pharmacist to take her place, she would have to close the counter. Prescriptions would get even more backed up. Patients would be upset. And the store’s performance, closely tracked by a series of corporate metrics, would suffer more than it already had.

Anderson couldn’t reach her boss, so she texted his assistant at 10:11 a.m.

“I know this sounds crazy but I am having symptoms of a heart attack. Can you get someone here long enough for me to go to the ER and get checked out?”

Three minutes later, the assistant called. The two spoke briefly, then hung up.

“I talked to Jessica,” Anderson texted Bowman, referring to the assistant. “She told me to close and go, but I told her to find someone if she could.”

Bowman replied: “Are you coming home or going to the closest ER? Do I need to pick you up?”

Home was 35 minutes to the south, in Henryville, Indiana. The closest emergency room was just down the street, at Schneck Medical Center. Anderson could drive there in three minutes.

The assistant called again, and the two spoke for 46 seconds.

Then Anderson sent Bowman what would be her final text: “Bob is coming now. I will go to Schneck here. Hopefully it’s nothing and I will come back to work.”

Fifteen minutes later, Anderson collapsed on the pharmacy floor.

A customer who happened to be a nurse raced behind the counter and started CPR while a pharmacy tech called 911, a coworker told 91Ӱ��.

First responders arrived within minutes. They ventilated her. They gave her chest compressions. They jolted her with a defibrillator. Nothing made a difference. They loaded her onto an ambulance and drove her to the emergency room at Schneck. Her pupils were fixed and she had no pulse.

Staff at Schneck administered three rounds of epinephrine to stimulate Anderson’s heart, but it had long since stopped pumping blood. Her skin became mottled.

She was gone.

An autopsy later revealed severe atherosclerotic cardiovascular disease with 99% blockage of her left descending coronary artery, leading to what’s referred to as a “widowmaker” heart attack. 

“If she had gone in quickly when she realized she was having a heart attack,” said Dr. Eric Topol, a longtime cardiologist and the executive vice president of Scripps Research, “the artery would have been opened up, and she most likely would have survived.”

By waiting, Anderson had made the ultimate sacrifice to an industry that notoriously demands too much of its workers.

Corporate culture's role blamed in Anderson's death

Over the past decade, corporations like CVS, Rite Aid, Walgreens and Walmart have steadily slashed pharmacy staffing levels while saddling remaining employees with a burgeoning list of additional duties.

Stores that once had two pharmacists and six pharmacy technicians filling an average of 500 prescriptions a day now may have half the staff and an even higher prescription volume – plus an endless crush of vaccine appointments, rapid COVID tests and patient consultation calls.

Every task is timed and measured against corporate goals that reward speed and profits. Staff who do not fill prescriptions fast enough, answer the phones quickly enough or drum up enough vaccination business can face discipline, reassignment or termination.

Read 91Ӱ��'s investigation:Prescription for disaster: America's broken pharmacy system in revolt over burnout and errors

No chain exemplifies this ethos more than CVS, dozens of current and former pharmacists told 91Ӱ��. Many recalled how they have been pressured to work through sickness, physical injuries and mental breakdowns.

One pharmacist said her boss refused to give her a day off even though she was suffering a full-blown panic attack. Another said he was asked to stay behind the counter instead of taking his injured son to the emergency room. Two pharmacists said they worked while actively miscarrying because their bosses couldn’t find anyone else to cover their shifts.

“You’re just programmed that if you’re sick or you need to go home, you can’t. You have to wait until someone comes,” said Wendy Lear, a former CVS pharmacist who worked while miscarrying.

Although she had never met Anderson, Lear knew her name.

They all did.

Word of Anderson’s death spread like wildfire among retail pharmacists. It became a cautionary tale of corporate martyrdom. It spawned a hashtag, #SheWaited, and a social media campaign that urged pharmacists to listen to their bodies, stand up to their bosses and take care of themselves.

Not long after she died, a bright orange billboard went up on Interstate 65 in Indiana, between Seymour and Henryville. It featured a photo of Anderson along with the hashtag and a simple message: “Your job can wait, your heart can’t.”

Anderson’s family had paid for the sign. 

“We were trying to get exposure to this, because we thought it would gain media attention, and CVS would have to deal with this on some level,” said Larry Anderson, Ashleigh’s father. “But unfortunately that didn’t pan out.”

91Ӱ�� interviewed Anderson’s father and stepmother, her long-term boyfriend and 10 former colleagues who worked with Anderson at various times during her career with CVS. Many of them described Anderson’s dedication to a job that, some of them believe, ultimately killed her. Some of those colleagues still work for the company and spoke on the condition of anonymity to protect their jobs.

The media organization also examined text messages and calls to and from Anderson’s phone the morning she died, as well as reviewed a summary of her final moments detailed in a coroner’s report obtained through a public records request. A reporter additionally spoke to dozens of retail pharmacists from CVS and other chains across the country about the conditions and demands of the job.  

Taken together, the interviews and records paint a portrait of an industry that conditions employees to work beyond their limits and put their own needs behind those of the job. So strong is the culture that those close to Anderson say that even when she got permission to close the pharmacy, she must have decided it was in her best interest to wait for backup before seeking help.

“She was, in our opinion, afraid to go to the emergency room and be told, ‘No it’s not a heart attack at all, it’s just anxiety,’” said her father, Larry Anderson. “Because then she would have to come back and face her bosses.”

Michael DeAngelis, CVS’ executive director of corporate communications, called Anderson’s death a “tragedy that never should have happened.” He pushed back, though, on the notion that CVS bears responsibility for her death, noting that she was told to leave and highlighting the company’s “culture of safety.” 

Under no circumstances, he said, does CVS expect or want its employees to work when they are unwell, and it encourages them to seek medical treatment when necessary.

“It's impossible for me to comment on why Ashleigh made the decision she made,” DeAngelis said. “I think, by and large, pharmacists are highly dedicated health care professionals, and I would not be surprised if there are pharmacists who have the mindset of, ‘I need to keep taking care of my patients,’ versus ‘I’m afraid of being punished by my employer.’”  

Although they acknowledge Anderson alone made the call to wait, Larry Anderson and his wife, Donna, still blame CVS for her death. If the company cared about its employees, Anderson said, it would have properly staffed its locations so that no one pharmacist was stuck behind the counter, reluctant to leave.  

“There is an intimidation factor,” Larry Anderson said. “You don’t feel like you can take your lunch. If you have a doctor’s appointment, you’re extremely reluctant to do it. You just can’t be away from work.”

Pharmacist was a rising star at CVS

Anderson grew up in and around Lafayette, Indiana, the eldest child and only daughter of Larry and his first wife, Nancy.

As a girl, Anderson was adventurous, spirited and naturally gifted. She excelled at everything, especially academics, and she had a soft spot for animals. Friends and family often called her “the smartest person in any room.” She didn’t even have to try.

She graduated high school as class valedictorian, and attended the prestigious Purdue University, located in her hometown. Anderson could have chosen any major, but she gravitated toward medicine and especially liked the idea of becoming a veterinarian. The only problem:  She hated the sight of blood. 

“She was maybe a year or two into college when she decided to go into pharmacy,” her father said. “Pharmacy was an option that allowed her to be in the medical field without seeing a lot of blood.”

Anderson threw herself into her studies, learned everything she could and earned a doctorate of pharmacy in 2004. She was 24 years old. Bursting with optimism and eager to prove her worth.

No one was surprised when she quickly landed a job. CVS was lucky to get her, they thought. Anderson felt like she was the lucky one. She loved everything about her work as a retail pharmacist – the fast pace, the stimulating environment, the patient interactions. It was endlessly challenging, and Anderson relished a challenge.

Her coworkers soon took note.

“I knew right from the start that she was going to be our next boss,” said Trish England, who worked as a pharmacy technician at the CVS in Columbus, Indiana, where Anderson started her career. “She was a rising star. She was the best pharmacist we had. They praised her for everything she did.”

CVS soon promoted Anderson to pharmacist in charge at one its busiest locations in the state. Employees working in Columbus at the time recall handling between 3,000 and 6,000 prescriptions a week. 

Anderson thrived in her managerial role. She was a master of the pharmacy who could rattle off the answer to any question, efficiently clear a queue of backlogged prescriptions and make patients feel like she really cared.

She ran a tight ship, her coworkers said, and was an absolute stickler for quality control.  

“CVS has a thing where technicians count prescriptions out and put them in a box that takes a picture and sends it to the pharmacist to verify and look at it,” said one pharmacy technician. “She made us take the pills and bundle them in groups of five so she could count them herself. We all grunted, like, ‘Why do we have to do this?’ But it was all for patient safety.”

Anderson’s competency initially intimidated some of her coworkers, who said they thought she was “scary” or “cold” until they got to know her. Then they became fiercely loyal, describing her as a true friend whose warmth was surpassed only by her wit. 

Managers at other stores sent their pharmacists to Columbus to train with Anderson. Around the time she won the company’s Paragon Award, she was invited into its emerging leaders program, a stepping stone to upper management. 

Anderson set her sights on a district leader position, a role overseeing a dozen or so pharmacies and ensuring they hit their corporate targets. She seemed a shoo-in for it. 

“She was one of the best pharmacists in the area,” recalled a CVS pharmacist who was sent to train under Anderson. “She was the kind of pharmacist people wanted other pharmacists to be.”

Then, one day, Anderson stunned her coworkers by leaving it all behind.

In August 2013, she abruptly transferred from the Columbus location to a lower-volume CVS in Greensburg, Indiana, where she worked an overnight shift as a staff pharmacist. She dropped out of the emerging leaders program. She stopped talking about career advancement. 

It made no sense, her colleagues said. Some figured she just needed a change. Others assumed corporate forced her out for falling short of its rising targets. 

“It was always numbers, numbers, numbers – you have to hit your numbers,” said a pharmacist who worked with Anderson in Columbus. “The district manager would come in and be like, ‘How come you can’t hit this number? How come you can’t hit that number?’”

At the same time, he said, the store’s prescription volume was exploding as staff size steadily dwindled. CVS decided not to replace a pharmacist who had recently left, and there were fewer technicians at any given time. 

“Working conditions just got worse and worse and worse,” England recalled. “The more we did, the more they expected us to do.”

When the numbers fell too far behind, “they took her out.”

But one former colleague said Anderson’s performance at the store wasn’t the issue. It was an ethics hotline complaint that led to her removal. 

A pharmacy technician took offense at the way Anderson had handled a situation, said the former colleague, a longtime CVS administrator who worked closely with Anderson over the course of her career. 

“She was snappy,” the colleague said of Anderson. “You have to be snappy in that job, but one day she said something in the heat of the moment that she probably should not have said.”

Human resources investigated the complaint, the colleague said, and determined Anderson should step down. The decision gutted Anderson, who felt she did not get a fair hearing.

“They knocked her down a peg,” Donna Anderson said. After that, she stopped trying to be anything more than a staff pharmacist.

Anderson spent the next several years commuting from Columbus to the CVS in Greensburg and then the one in Shelbyville and then the one in Nashville, Indiana. All were within 30 miles of her house. 

When she and Bowman bought a newly constructed home in Henryville, 50 miles to the south, Anderson sought a shorter commute.   

She found it in Seymour.

Anderson feared dying alone

The final CVS in Anderson’s career sat at the intersection of a busy commercial strip, flanked by a large parking lot, which on that late summer morning was teeming with emergency vehicles.

Khandie Tharp would have seen them had she pulled in just minutes earlier. But the pharmacy tech was late for her shift, and, by the time she arrived, the lot was eerily empty except for two crying coworkers.

One of them approached Tharp as she got out of her Mustang to tell her what had happened. Distraught, Tharp got back in her car and drove to the hospital.

During her 18 months working at the Seymour CVS, Tharp had bonded with Anderson. The experienced pharmacist had taken the new tech under her wing and given her the support she needed to excel in an environment rife with seemingly endless tasks.

In rare lulls, the two shared details about their lives and learned they had a lot in common. As neither of them had any children, they confided in each other about their fears of dying alone.

Tharp was determined that morning not to let that happen.

She introduced herself to the emergency room receptionist and asked that someone inform Anderson of her presence. Since she was not family, staff could say nothing about her friend’s condition but promised to let someone know Tharp was there.

And then she waited.

“I wanted her to know that somebody was there for her,” Tharp said. “I was there for her.”

Bowman was at home when his phone rang. The call came from the CVS store in Seymour, and when he answered, he heard the rattled voice of another pharmacy tech saying Anderson had collapsed and that paramedics were on their way.

Bowman jumped in his vehicle and kept a lookout for state troopers as he sped north on I-65 to Schneck Medical Center, not knowing what he would find when he got there.

Tharp greeted him when he arrived. The two had never met, but she recognized him from photos Anderson had shared. Bowman was grateful she was there.

A doctor appeared and asked Bowman to follow him into a room. Bowman knew right then that Anderson was gone. He remembers feeling his feet carry him into the room and his ears listen to the doctor explain that her heart had stopped.

The explanation ended, and Bowman was led into another room. This one held Anderson’s body. Bowman was given time to say goodbye.

Time passed – five minutes, an hour, an eternity – before Bowman reappeared in the waiting room. He looked at Tharp and shook his head. She knew then, too. Tharp felt her knees buckle. Bowman caught her before she fell. Then the two strangers cried together in the hospital over a woman they both loved.

It was Bowman who broke the news to Anderson’s parents.

When they saw his number pop up on their phone, Larry Anderson said, he and Donna figured Bowman was calling to thank them for the large patio umbrella they’d had delivered that morning to his house.

Instead, Larry Anderson said simply, “What a shock.”

91Ӱ�� seeks answers amid misunderstanding

When the shock wore off, the family wanted answers as to how a seemingly healthy, active woman in the prime of her life could collapse and die at work.

They knew CVS had expected Anderson to work through lunch breaks and bathroom breaks, that she felt pressured to come in even when she was sick. They knew her job stressed her. Now they wanted to know if it killed her.

Larry Anderson said he found the numbers for his daughter’s boss and his assistant and called them, but neither one would talk.

“After two or three attempts, her boss finally did talk to me, but he was very careful of what he would say to me,” Larry Anderson said. “He said he had been instructed not to answer (questions) and said ‘I shouldn't even be talking to you.’ But he was trying to be nice.”

Even the company’s gesture of establishing a scholarship in his daughter’s name at Purdue fell flat, he said, when CVS made a one-time donation of $10,000 that December instead of sustaining it annually as the family thought it would. 

DeAngelis denied that CVS avoided conversations with the family or that it ever committed to funding a scholarship beyond the one-time donation. 

“We regret if there was any misunderstanding,” he said.

Misunderstanding was taking root online, too. Messages about Anderson’s death started appearing on Facebook, Reddit and Twitter. They claimed her bosses had forbidden her from seeking immediate medical attention and made her wait until a backup pharmacist arrived. 

Among those who saw the posts was Bled Tanoe, a former Walgreens pharmacist who amassed a large online following advocating for better retail pharmacy working conditions under the hashtag #PizzaIsNotWorking – a nod to companies’ hollow offerings of free pizza to appease stressed employees.

Anderson’s death struck Tanoe as further evidence of an industry that mistreats its employees, she told 91Ӱ��. She wanted to amplify the story and create a new hashtag around it. So she reached out to CVS pharmacists in Indiana to verify the story. They confirmed that Anderson could not leave, according to messages Tanoe shared with 91Ӱ��. 

In October, Tanoe launched the #SheWaited hashtag, and the story exploded among retail pharmacists online. By the time Tanoe heard the details might not be correct, she said, her sources had either stopped talking or were no longer sure, and the story had already taken on a life of its own. 

Regardless, Tanoe said, the message behind the movement she started remains the same.

“It is established in our profession, there is a culture where you cannot put yourself first,” said Tanoe, who also is the vice president of the online pharmacist advocacy community, RPhAlly. “It might not be written in a handbook and they would never say it to your face, but the message, through their actions, is that the company comes first.”

In the two years since her death, Anderson’s name has transcended social media. 

It now echoes through the college classroom of Haley Howard, an assistant professor of pharmacy practice at Manchester University in Fort Wayne, Indiana, where she teaches first-year students about professional self-advocacy.

Howard uses Anderson’s story to remind her students that they have a right to reasonable working conditions and to voice their concerns. Most importantly, she tells them, they can’t fulfill their duty to care for their patients if they don’t take care of themselves first. 

It’s one of several examples Howard includes in an accompanying slide show that shares advice with future pharmacists about how to advance their career at a time when many are leaving the profession and enrollment to pharmacy schools is in decline.

Howard, who also works as an acute care pharmacist at Cameron Memorial Community Hospital in Angola, Indiana, never met Anderson. But she said she heard about her death from a fellow pharmacist who had heard about it from somebody else. It felt, she said, like a wake-up call that more people needed to hear.

“Pharmacists need to be in safe working environments,” Howard said. “I wanted to share with my students and say, ‘This stuff happens in pharmacy, and it shouldn’t be happening.’”

Emily Le Coz is a reporter on the 91Ӱ�� investigations team. Contact her at elecoz@usatoday.com or on X @emily_lecoz.